[Biliary lesions after laparoscopic cholecystectomy]. / Lesioni biliari dopo colecistectomia laparoscopica.

Laparoscopic cholecystectomy is the suitable treatment for symptomatic cholelithiasis, even if the incidence of biliary lesions following this procedure may be up to threefold higher than that of open cholecystectomy. We report our experience concerning the incidence, aetiopathogenesis, diagnosis and treatment of complications in a homogeneous group of laparoscopic cholecystectomies. In a total of 492 laparoscopic cholecystectomies only three bile duct lesions were observed (0.6%); they were classified according to Bismuth and re-assessed according to Strasberg. They consisted in two biliary leakages and one bile duct stricture. All patients were evaluated by full blood test, ultrasonography and endoscopic retrograde cholangiopancreatography. Endoscopic treatment was successful in the two patients with biliary leakage, while the patient with a stricture required surgical therapy. In conclusion, we suggest that a correct knowledge of the aetiopathogenesis together with a multidisciplinary approach to the diagnosis appear to be the best method for the detection, complete classification and most suitable treatment of symptomatic cholelithiasis.

Simple versus double jejunal pouch for reconstruction after total gastrectomy.

BACKGROUND: Even though many types of reconstruction after total gastrectomy have been proposed to reduce postgastrectomy syndromes, choosing a method that would further improve the quality of life and nutrition of the gastrectomized patient is controversial. Hunt-Lawrence single pouch reconstruction seems to obtain better results compared with the more common Roux-en-Y technique, but both of these reconstructive approaches are associated with some reduction in food intake and some problems in achievement of ideal body weight. METHODS: In this prospective, randomized trial, after total gastrectomy 18 patients had reconstruction according to the Hunt-Lawrence or single pouch technique (SP group), whereas for 23 patients, the technique was modified with construction of a second pouch in the distal portion of the jejunal loop (DP group). Patients in the two groups were compared at 12 months after surgery for problems in gastrointestinal function, quality of life, improvement in body weight and nutritional parameters, serum albumin, hemoglobin level, and serum protein. RESULTS: The DP group demonstrated fewer symptom problems, better weight maintenance, and better laboratory values when compared with patients undergoing standard single jejunal pouch reconstruction. CONCLUSIONS: Reconstruction with use of a double pouch as a gastric substitute leads to better outcome assessments than with a single pouch reconstruction. Our double pouch technique has demonstrated significant improvement in quality of life and nutritional recovery in terms of functional results as well as patient satisfaction.

[Vascular clamping in cirrhotic liver surgery]. / Il clampaggio vascolare nella chirurgia del fegato cirrotico.

Different vascular clamp methods in liver surgery have led to less complications. The aim of this study was to evaluate the results after hepatic resection involving different vascular clamping methods and liver function outcome. Our study examined 46 patients who underwent surgery for liver lesions, developed on cirrhotic and noncirrhotic livers, applying the technique of selective clamping and pedicular clamping. There was one death (1/17; 5.9%) due to postoperative liver failure which occurred in a cirrhotic liver patient who underwent left hepatectomy with pedicular clamping. Complication rate was higher, but not significant (4/7; 57.1%) in the group with selective clamping compared to those with pedicular clamping (3/10; 30%). Hemorrhagic complications were observed in a higher rate among patients with selective clamping (3/7; 42.9%) compared to those with pedicular clamping (1/10; 10%). Selective clamping seems to find major indications in patients with chronic liver disease undergoing minimal hepatic resections. Intermittent pedicular clamping seems to be more effective in regards to blood loss and postoperative hepatic function.

Positional candidate gene approach and functional genomics strategy in atopy gene discovery.

As part of our effort in searching for genetic factors contributing to the susceptibility to atopy and asthma, we have focused on a 'positional candidate' approach in identifying CC chemokine gene polymorphisms and their functional correlates. To date, a single-nucleotide polymorphism was found in the RANTES proximal promoter region, and a high degree of sequence variation was identified in the 3'-untranslated region -of the eotaxin gene. Also, we are pursuing a series of functional genomics' studies designed to identify differentially expressed genes in a panel of allergen-specific human Th2 cells and in antigen-induced hyperreactive murine airways. This is performed using a combination of protocols including suppression-subtractive hybridization and cDNA array hybridizations with 18,363 nonredundant sequences. A data base is being generated from a list of subtracted cDNA sequences and array-positive clones to categorize differentially expressed genes. Sequences are being placed in biologically relevant categories on the basis of function (i.e., receptor, signal transduction pathways, transcription, and translation). With the increasing amount of sequence information compiled by the Human Genome Project, it will be particularly challenging to integrate functional gene-mapping efforts to define and compare aberrant genotypes/phenotypes in atopic diseases.

A novel factor produced by placental cells with activity against HIV-1.

The factors controlling the dynamics of HIV-1 transmission from mother to infant are not clearly known. Previous studies have suggested the existence of maternal and placental protective mechanisms that inhibit viral replication in utero. Preliminary studies from our laboratory revealed that supernatant from placental stromal cells protected HIV-1-infected PBMC from virus-induced apoptosis and suppressed virus production. We have attempted to characterize the antiviral activity of this placental factor (PF) and delineate the stages of HIV-1 replication affected. This activity was not due to the presence of any known cytokine reported to have anti-HIV effect. Direct exposure to PF had no suppressive effect on the infectivity of cell-free HIV-1, and envelope-mediated membrane fusion appeared to be unaffected. Western blot analysis of HIV-1 from infected PBMC treated with PF revealed that expression of all viral proteins was reduced proportionately, both intracellularly and in released virions. However, exposure of HIV-1-infected cells to PF resulted in production of virions with 10-100-fold-reduced infectivity. PF-treated virions contained two- to threefold reduced ratios of cyclophilin A:Gag protein as compared with untreated virus. Reduced cyclophilin A content resulting in decreased binding of cyclophilin A to Gag could account, in part, for the observed reduction in infectivity. Our results suggest that placental cells produce an antiviral factor that protects the fetus during gestation and may have therapeutic potential.

Blind versus open approach to laparoscopic cholecystectomy: a randomized study.

Intraabdominal structures may be damaged during blind introduction of the first trocar for laparoscopic operations. In this study, 150 patients with gallbladder lithiasis who underwent laparoscopy were randomly assigned to two groups, a blind (V group) or an open (H group), in order to compare the results and the rate of complications. No mortality was observed. Major complications occurred in 3/75 (4%) patients of the V group and in 1/75 (1.3%) patient of the H group (p < 0.05). Minor complications occurred in 5/75 (6.7%) patients of either group. The achievement of pneumoperitoneum required 4.5+/-0.4 min in the V group and 3.2+/-0.2 min in the H group (p < 0.05). The open laparoscopic technique is safer and faster than the blind approach; therefore, it is proposed that this approach be routinely used in all laparoscopic procedures.

Targeted transduction of CD34+ cells by transdominant negative Rev-expressing retrovirus yields partial anti-HIV protection of progeny macrophages.

Congenitally acquired HIV infection may be uniquely suited to treatment via genetic engineering of CD34+ hematopoietic stem/progenitor cells. However, current technologies yield only a small percentage of mature cells that carry the inserted genes, and expression is frequently suppressed. Since clinical trials employing these methodologies have been proposed for anti-HIV gene therapy of HIV-infected children, we wished to assess, by in vitro modeling, the expected limits of transduction efficiency, expression, and antiviral activity using currently available methods. We measured retrovirus-mediated transduction in cord blood progenitors and their in vitro-derived progeny macrophages by Mo-MuLV vectors expressing a transdominant negative Rev (RevTD). CFU-GM transduction efficiency ranged from 7 to 85%, with an average of 28%. Semiquantitative DNA PCR demonstrated < or =100 vector sequence copies per 1000 cells in monocyte/macrophage cultures, which were grown without selection to better model in vivo conditions. When challenged with the macrophagetropic HIV-1BaL isolate, cultured macrophages from mock-transduced CFU-GM colonies supported infection in eight of eight experimental cultures, control LXSN-transduced progenitors supported infection in six of eight cultures, while macrophages derived from RevTD-transduced CFU-GM colonies supported infection in four of eight cultures. Although these results support the ability of neo(r) retroviral vectors containing RevTD to inhibit HIV replication, they indicate that further optimization of transduction efficiency and sustained expression will be required for effective anti-HIV protection in vivo.

[The role of necrosectomy and continuous peritoneal lavage in the treatment of acute necrotic-hemorrhagic pancreatitis]. / Il ruolo della necrosectomia e del lavaggio peritoneale continuo nel trattamento della pancreatite acuta necrotico-emorragica.

Acute necrotizing pancreatitis involves high mortality. When diagnosed, the disease implies a choice of suitable timing and proper technique of surgical approach. The experience on 16 patients with acute necrotizing pancreatitis, 9 males and 7 females, mean age of 54.7 +/- 3.3 years, is presented in this study. Necrosectomy and continuous local lavage of abdominal collections and pancreatic necrotic surfaces was the most appropriate surgical treatment. The method seems able to remove necrosis and active biological compounds and would appear to achieve a limited mortality and morbidity. Necrosectomy and postoperative local lavage represent a therapeutic effective procedure.

[The role of esophageal sphincter tonus and of gastric motility in the extent of reflux esophagitis]. / Ruolo del tono sfinteriale esofageo e della motilità gastrica sull'entità dell'esofagite da reflusso.

Thirty-two patients with symptomatic gastroesophageal reflux disease were investigated by esophagogastroduodenoscopy, 24 h pH monitoring, esophageal manometry and measurement of gastric emptying of solids, in order to elucidate the relative importance of lower esophageal sphincter tone, amount of acid reflux and gastric emptying on the degree of esophagitis. The mechanical competency of lower esophageal sphincter was significantly deranged in patients with moderate/severe esophagitis than in patients with mild esophagitis. The gastric emptying time was significantly delayed in patients with moderate/severe esophagitis than in patients with mild esophagitis. No relationship was observed between amount of acid reflux, lower esophageal sphincter function and gastric emptying time. Our results suggest that resting pressure of lower esophageal sphincter and the gastric motor function play a major role in severity of reflux esophagitis.

[Vascular compression syndrome of the duodenum. Diagnostic and therapeutic update]. / La sindrome da compressione vascolare del duodeno. Attualità diagnostiche e terapeutiche.

Superior mesenteric artery syndrome is an uncommon clinical condition. A case of duodenal vascular compression and a review of the literature are reported in order to clarify the pathophysiology of the disease. Diagnostic values of hypotonic duodenography and angiography are emphasized. Although, the significance of long-term pH monitoring and gastric emptying for preoperative study and its importance in follow-up after the surgical treatment are evaluated.

[Treatment of acute cholecystitis, yesterday and today: the role of diagnostic research]. / Il trattamento della colecistite acuta, ieri ed oggi: ruolo delle indagini diagnostiche.

To evaluate the influence of both ultrasonography and cholescintiscan on the choice of the treatment and prognosis of acute cholecystitis, the authors reviewed their series of 187 patients observed between 1974 and 1985. On the basis of diagnostic investigations employed, two distinct periods are considered, 1974-79 and 1980-85. In the I period, the exact diagnosis of the disease was obtained in 31 patients (26.3 percent) and the treatment was conservative in 81.3 percent of cases and surgical in 18.7 percent. In the II period, the disease was exactly diagnosed in 95.6 percent and all patients underwent surgery. The overall mortality and complication rate was respectively 5.1 percent and 11.8 percent in the I period and 1.1 percent and 5.8 percent in the II period. Authors conclude that ultrasonography and cholescintiscan, arising rapidly to the exact diagnosis of disease, influenced markedly the choice of surgical treatment, improving the prognosis of these patients.

[Indications and role of ultrasonography, transhepatic percutaneous cholangiography and endoscopic retrograde cholangiography in obstructive pathology of the distal choledochus]. / Indicazioni e ruolo della ultrasonografia (us), della colangiografia percutanea transepatica (ptc) e della colangiografia retrograda endoscopica (erc) nella patologia ostruttiva del coledoco distale.

The authors refer the results obtained with ultrasonography (US), percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiography (ERC) in the diagnosis of obstructive jaundice. One-hundred and forty-four patients have been investigated, on the basis of biological, clinical and ultrasonographic findings, by PTC or ERC. The high percentage rate observed in PTC-approached patients suggests that the combination of US-PTC would appear to provide an important role in diagnosing obstructive jaundice.

[Inhibitory effect of somatostatin on the secretion of duodenal gastrin]. / Effetto inibitorio della somatostatina sulla secrezione di gastrina duodenale.

This study covers 14 patients subjected to truncal Vagotomy + Antrectomy acc. BI, in order to ascertain whether somatostatin is capable of inhibiting duodenal gastrin release. Somatostatin infusion significantly inhibits the gastrinic response to a protein meal, but does not affect basal levels of the hormone. This suggests that facilitation of duodenal gastrin release after vagal section may be mediated by the reduced somatostatin release.

[Triazolam in the treatment of presurgical patients]. / Il triazolam nel trattamento di pazienti prechirurgici.

The therapeutic action of Triazolam has been assessed against a placebo by administering the two substances on a double blind basis the evening prior to surgery. The results show that Triazolam was significantly better than the placebo as regards induction time and the duration and quality of sleep. There were few unimportant side-effects.

[Autograft of pancreatic tissue in the spleen of pancreatectomized dogs]. / Autotrapianto di tessuto pancreatico nella milza di cani pancreatectomizzati.

The intrasplenic autotransplant of pancreatic fragments in dogs subjected to total pancreatectomy can prevent diabetes as it maintains normoglycaemic condition and a normal insulinaemic response to i.v. infusion of glucose. By adopting a pancreatic tissue preparation technique which provides for a very short collagenasis digestion time (4 minutes), B cells took and normal glucidic metabolism was maintained.